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DONATION/SPONSORSHIP REQUEST FORM

Donation/Sponsorship Request

Truman Orthodontics appreciates the opportunity to consider new sponsorships in our ongoing mission to help our community. Due to demand and budget, please complete the following form at least 30 days prior to your deadline for our Sponsorship Committee to review.

One sponsorship will be chosen per month.

Today's Date:

Name of Applicant (required)Email (required)Telephone number:
Are you or your children a patient or former patient?YesNo
Which Truman Orthodontics office would you like to send your request to?HendersonSummerlinOrganization Name (required)
Address if return correspondence is needed:

What type of donation are you seeking? (required)Truman Orthodontics Promotional ItemDonationSponsorshipAuction ItemOtherDate donation/sponsorship is needed by: (required, must be at least 30 days from today)
Amount Requested $
Make check payable to:
Team Name/Age Level
City
Website/Link to Event
When and Where is the Event?
Are you in need of volunteers from Truman Orthodontics?YesNo
If yes, is there a volunteer coordinator/contact?

Please provide a brief narrative of what your donation/sponsorship request entails and what it would mean to you and the organization if chosen: (required)